Two cases of tetanus are presented, and the diagnosis, clinical features, and management of tetanus are reviewed. The first patient, an 86-year-old woman, had marked muscle rigidity but was able to breathe spontaneously. A dark eschar with purulent drainage was noted on her left foot, but Clostridium tetani was not isolated. She was placed in a semidark room and was treated with penicilin G; tetanus immune globulin (TIG) 5,000 units i.m.; tetanus toxoid 0.5 mL i.m.; diazepam, chlorpromazine, and morphine for sedation, muscle relaxation, and analgesia; ranitidine for stress ulcer prophylaxis; heparin for prevention of deep-vein thrombosis; and peripheral-vein nutrition. Her condition improved gradually, and she was discharged to a rehabilitation institute after 32 days. The second patient, a 46-year-old woman, experienced progressive descending paralysis and required ventilatory support. She had a periodontal abscess, but cultures of the drainage were negative. She was placed in a semidark room and treated with erythromycin, TIG, tetanus toxoid, diazepam, pancuronium bromide, morphine, ranatidine, and heparin. Autonomic instability occurred during the second and third weeks, but cardiac output was maintained without treatment. The patients was extubated after five weeks, and was tranferred out of the intensive-care unit the following week. The diagnosis of tetanus is based primarly on characteristic findings of muscle rigidity and reflex spasms; cultures for C.tetani are of limited value. A history of trauma or injury is common. Pulmonary infections and cardiovascular instability are the most common complications. Therapy consists of ventilatory support; control of neuromuscular symptoms with benzodiazepines, narcotics, and neuromuscular blockers; antibiotic therapy; management of autonomic instability with β blockers or other cardiovascular agents; and general supportive measures to prevent or treat complications and provide patient comfort. The management of tetanus is primarily supportive; airway maintenace and prevention of complications are important determinants of outcome.
|Original language||English (US)|
|Number of pages||5|
|Publication status||Published - Jan 1 1987|
ASJC Scopus subject areas
- Pharmaceutical Science